Ovarian hyperstimulation syndrome (OHSS) - grade 5

Case contributed by René Pfleger


Abdominal bloating.

Patient Data

Age: 35 years
Gender: Female

Symmetric enlargement of both ovaries (> 12 cm in size), containing cysts of varying size in a spoke wheel pattern. Intense ovarian blood-flow on Doppler US (not shown) without evidence of ovarian torsion.

Free peritoneal fluid as simple fluid, including perihepatic and perisplenic location.

Right greater than left bilateral pleural effusions.

Background history:

Ovulation induction. In vitro fertilization nine days prior to admittance. 
Clinical findings include abdominal distortion and dyspnea. No fevers. No focal abdominal tenderness.
Blood samples reveal moderate leukocytosis, further details temporarily withheld.

Right thoracocentesis was performed and revealed serous hydrothorax.

Hemoconcentration with Hgb 10.2 mmol/L and Hematocrit 0.50.

Normal Creatinine level and eGFR reflecting normal kidney function.


Case Discussion

Example of ovarian hyperstimulation syndrome (OHSS) 9 days after IVF.

Associated ascites, symptomatic pleural effusions and hemoconcentration, severe OHSS grade 5,  but no evidence of acute kidney failure. Hypoalbuminemia is a universal finding in OHSS.

Rapid symptom relief after right thoracentesis and subsequent general improvement.

There is no specific treatment for OHSS and as such therapy is mainly supportive. OHSS is self-limiting in its course and syndrome severeness typically parallels serum bHCG levels. However fatal outcome has been reported 1-3.

Awareness of the entity and possible findings by the radiologist is crucial, as OHSS can range from mild to potentially devastating with pulmonary edema, hydrothorax, arterial and venous embolism, tamponading pericardial effusions and myocardial ischemia inter alia. Prompt recognition and supportive therapy can prove life-saving.

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